Data from a large-scale local deployment of the Baylor Health Care System (BHCS)/Institute for Healthcare Improvement Outpatient Trigger Tool (BI-OTT) indicate the presence of a substantial burden of adverse events (AEs) in ambulatory primary care (13.5 AEs/100 pt years). Deployment of this measurement strategy represents, itself, an intervention related to improving the quality of ambulatory primary care. Based upon refinement of the BI-OTT tool and process and a second large scale deployment, an opportunity exists to ready this intervention for broader use and to test its utility as an improvement intervention itself, to evaluate the impact of a specific patient safety intervention upon the rate of AEs, and to initiate an economic analysis of the impact of AEs taking place in ambulatory primary care. Specific aims of the proposed work are: 1) To develop a dissemination package of training materials and implementation tools for adoption by other organizations to enable them to effectively use the BI-OTT to measure the rate of AEs;2) To test the effectiveness of the dissemination package in providing a reliable and valid measurement system for AEs outside of its development environment;3) To evaluate the economic impact of identified ambulatory AEs from the perspectives of the patient, primary care provider, payer, employer, and society;4) To test the ability of the BI-OTT to detect ambulatory primary care-derived AEs known to result in hospitalization and/or ED use;and 5) To use the BI-OTT to quantify the effects of deploying an ambulatory electronic health record on the rate of adverse drug events. BHCS will collaborate with Research Triangle Institute to develop and deploy the dissemination package, to include a training video, Web site, and downloadable version of the BI- OTT electronic data collection tool. Dissemination will be tested within the Parkland Health and Hospital System (a safety-net provider in Dallas, Texas), the Mid-Atlantic Kaiser Permanente Medical Group, and Providence Health Services. Presuming demonstrable effectiveness, this work will facilitate widespread dissemination of a standardized reliable tool to detect and characterize primary care AEs, demonstrate the utility of this tool for evaluating other safety interventions more broadly, and provide valuable information regarding the costs associated with primary care-derived AEs. These data may help to inform decision-making at the provider level (related to potential investments to improve patient safety) and at the policy level related both to prioritization of safety initiatives and potential realignment of reimbursement strategies to better apportion both cost and resultant savings of investments to improve patient safety. PUBLIC HEALTH RELEVANCE: Although ambulatory care accounts for the majority of health care encounters in the United States, relatively little attention has been paid to patient safety and adverse events (AEs) in this setting. The proposed project will provide a means of broadly disseminating a measurement tool to track and characterize primary care-derived AEs, demonstrate the utility of this tool in evaluating effectiveness of patient safety initiatives in the primary care setting, and contribute valuable information regarding costs associated with primary care-derived AEs to inform provider and policy decisions regarding prioritization of safety initiatives and potential realignment of reimbursement strategies to better apportion costs and resultant savings related to investments in safety initiatives. This work has significant implications for public health, as all of the project aims address vital steps in reducing the risk of patient harm in the most frequently utilized health care setting.